51167.2IPA
APPLICATION FOR PLUMBING PERMIT
i < �� CITY OF CUPF.RTINO
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s o Sxnitiw No.
0 7 [. a�ellll 7 ,'!y P't' 196-8 Permit No 51167. �—
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°�1) %/Applieation,its�hereby made to the City of Cupertino for a permit to install plumbing
o a pipes'and/oy,Lxture'sl'lis,ted,on the reverse side hereof, and agrees to install said prices
> and/or fixtures in a¢ocdancc with the provisions of the Plumbing Code of the City of
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Cupertino, and all either laws applicable thereto. - - -
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Dwelling. r
,� Use of Premises-
- 3 Owner Ditz Crane Compal Addr ss De La Cram Boulevard
of Palm Plumbing Company 123h Sunnyvale—Saratoga Road
J a By ress
3 t -CONTRACTOR, AGENT
- `m Phone 2I�5-2323
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166579
;/State License Approved
—/- PWMBI X INSPECTOR . /
V V �
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Heater
Size 40(
Water Closet
Material �.
Bath Tub
/
To Curb
Shower
/
To Prop. Line //
Lavatories
Lj
To Existing
Kitchen Sink
/
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
/
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
'
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TO'T'AL FEES
Urinal
Fixture Fee
Area Drain
Main Thain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Rater Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Total Fee